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Mediastinoscopy in Mesothelioma Patients

The thoracic cavity enclosed by the rib cage lodges the heart covered
with pericardium in the center and the lungs covered with pleura on each
side. The interval between the two pleural sacs is known as the mediastinum.
It is an area of fatty tissue in which various organs lie embedded. The
mediastinum consists of four parts: superior, middle, anterior, and posterior.

The mediastinoscopy procedure is done by a chest surgeon. The images
are displayed on a video monitor which allows the surgeon to take appropriate
decision. The procedure is usually done to look for cancers, infections
and inflammations. If cancer is suspected, a tissue sample (biopsy)
is taken which will be examined under microscope. Staging of cancer also
is done by looking at the extent of spread of the cancer. The most common
use of mediastinoscopy is staging in patients with non-small cell lung
cancer (NSCLC).

The patient fasts to have an empty stomach. Before the procedure, an
intravenous line is placed to administer fluids and drugs. A local anesthetic
is applied to the throat and an endo-tracheal tube is inserted in to the
trachea to aid breathing. Mediastinoscopy is performed under general anesthesia.
After the anesthesia is given, the surgeon makes a small incision in the
“Burn’s space” in the lower part of the front of the
neck just above the sternum (breast bone).

The surgeon introduces the mediastinoscope through the incision. The
mediastinoscope is a long, narrow ,hollow tube with lights attached to
it. The surgeon examines the different structures of the mediastinum.
If he suspects any cancer, he takes a tissue bit (biopsy) from that area.
After fully examining the mediastinum, he withdraws the scope and closes
the incision with a few sutures and covers it with a bandage.

In a healthy person the mediastinoscopy will show small and smooth lymph
nodes and there will be no abnormal tissues or any signs of infection.
In sick patients, there may be enlarged lymph nodes, presence of abnormal
growth which may be cancerous and signs of infections and other diseases
like sarcoidosis.

The procedure takes about one hour. Patients are kept in the hospital
untll they recover from anesthesia. Patients can sometimes return to work
over the next few days during which period they take medications to ward
off infection and for pain relief. If non-absorbable sutures are used
for closing the incision, the patient may have to return after 5-7 days
for suture removal. The surgical scar usually heals within 5-7 days.

Mediastinoscopy is used for in the diagnosis and detection of mesothelioma
as well as other malignant conditions like lung cancer and lymphoma. It
is also used to detect tuberculosis, where the procedure may reveal tubercles,
enlarged lymph nodes and collection of fluid in the pleural sacs.